Epidemiology and outcomes of invasive candidiasis due to non-albicans species of Candida in 2,496 patients: data from the Prospective Antifungal Therapy (PATH) registry 2004-2008

PLoS One. 2014 Jul 3;9(7):e101510. doi: 10.1371/journal.pone.0101510. eCollection 2014.

Abstract

This analysis describes the epidemiology and outcomes of invasive candidiasis caused by non-albicans species of Candida in patients enrolled in the Prospective Antifungal Therapy Alliance (PATH Alliance) registry from 2004 to 2008. A total of 2,496 patients with non-albicans species of Candida isolates were identified. The identified species were C. glabrata (46.4%), C. parapsilosis (24.7%), C. tropicalis (13.9%), C. krusei (5.5%), C. lusitaniae (1.6%), C. dubliniensis (1.5%) and C. guilliermondii (0.4%); 111 infections involved two or more species of Candida (4.4%). Non-albicans species accounted for more than 50% of all cases of invasive candidiasis in 15 of the 24 sites (62.5%) that contributed more than one case to the survey. Among solid organ transplant recipients, patients with non-transplant surgery, and patients with solid tumors, the most prevalent non-albicans species was C. glabrata at 63.7%, 48.0%, and 53.8%, respectively. In 1,883 patients receiving antifungal therapy on day 3, fluconazole (30.5%) and echinocandins (47.5%) were the most frequently administered monotherapies. Among the 15 reported species, 90-day survival was highest for patients infected with either C. parapsilosis (70.7%) or C. lusitaniae (74.5%) and lowest for patients infected with an unknown species (46.7%) or two or more species (53.2%). In conclusion, this study expands the current knowledge of the epidemiology and outcomes of invasive candidiasis caused by non-albicans species of Candida in North America. The variability in species distribution in these centers underscores the importance of local epidemiology in guiding the selection of antifungal therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antifungal Agents / pharmacology
  • Antifungal Agents / therapeutic use*
  • Candida / drug effects*
  • Candida / isolation & purification
  • Candidiasis, Invasive / drug therapy*
  • Candidiasis, Invasive / epidemiology
  • Candidiasis, Invasive / mortality
  • Child
  • Child, Preschool
  • Drug Therapy, Combination
  • Echinocandins / pharmacology
  • Echinocandins / therapeutic use
  • Female
  • Fluconazole / pharmacology
  • Fluconazole / therapeutic use
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Registries
  • Survival Rate
  • Treatment Outcome
  • Young Adult

Substances

  • Antifungal Agents
  • Echinocandins
  • Fluconazole

Grant support

This data collection and analysis was supported by Astellas Pharma, US. Billy Franks, an employee of Astellas Pharma., provided statistical analysis support as well as being involved in manuscript preparation and authorship. Statistical programming support was provided by Alan Fan from Astellas. Editorial support (including editing for journal style, collating comments, and routing reviews), funded by Astellas, was provided by Jonathon Gibbs BSc., a medical writer at Envision Scientific Solutions.